Fat Grafting Improves Foot Pain Associated with Fat Pad Atrophy of the Heel: Early Findings from a Randomized Controlled Clinical Trial
Isaac James, MD, Beth Gusenoff, DPM, Sheri S. Wang, BS, Gabriella DiBernardo, BS, Danielle T. Minteer, PhD, Jeffrey Gusenoff, MD.
University of Pittsburgh, Pittsburgh, PA, USA.
PURPOSE: The heel contains specialized fat pads which protect the foot from harsh repetitive stress generated during the gait cycle. These fat pads are divided into a thin, superficial microchamber (MIC) and a thicker, deeper macrochamber (MAC). Fat pad atrophy of the MAC causes pain with ambulation and can cause substantial disability. Current management is limited to offloading orthotics and padding. The present study describes use of autologous fat grafting to treat heel fat pad atrophy.
METHODS: As part of an ongoing randomized, controlled crossover trial. Fat was harvested from the abdomen by manual liposuction, processed and injected by Coleman technique, and introduced into the macrochamber fat compartment (MAC) of 7 patients (11 feet) with an average volume of 6.9cc per heel. Patients were offloaded in a customized Darco shoe for 4wks post-operatively. Ultrasound-measured tissue thickness (Figure 1), pedobarograph-measured foot pressures, and Manchester Foot Pain and Disability Index (MFPDI) were obtained pre-operatively and followed for 1 year post-operatively. Outcomes were compared against a randomly selected control group (5 patients) who received standard of care offloading only.
RESULTS: Average age was 58 years. Average BMI was 30.5. No patients were active smokers or diabetic. When compared to controls, subjects who received fat grafting had significantly greater fat pad thickness at 6 and 12 months both at rest and under load (p<0.05) (Figure 2). On pedobarograph, standing heel forces and pressures trended up across all time points while walking heel forces and pressures trended down across all time points. On the MFPDI, patients receiving fat grafting had significantly improved foot pain (p=0.015) and foot appearance (p=0.048) scores at 6 months (Figure 3).
CONCLUSION: Our current data suggests that fat grafting can restore foot function in patients with heel fat pad atrophy by preserving shock absorbing soft tissue and reducing pain. This has allowed many of our patients to resume previously untolerated activities. However, these findings will need to be corroborated in a larger sample and longer follow up which our ongoing trial aims to provide.
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